38.2-3541.2 - Enrollment following change in eligibility status under assistance programs.
§ 38.2-3541.2. Enrollment following change in eligibilitystatus under assistance programs.
A. As used in this section, "assistance program"means the Commonwealth's medical assistance services program, establishedpursuant to § 32.1-325, or the Family Access to Medical Insurance SecurityPlan, established pursuant to § 32.1-351, including under any waiver ordemonstration project conducted under or in relation thereto.
B. Any employer providing health insurance coverage for hisemployees under a group accident and sickness insurance policy, or subscriptioncontract, or other evidence of coverage shall permit an employee who iseligible, but not enrolled, for coverage under the terms of the policy,contract or plan, or a dependent of such an employee, if the dependent iseligible but not enrolled, for coverage under such terms, to enroll forcoverage under the terms of the policy, contract or plan, if either of thefollowing conditions is met:
1. The employee or dependent has received health insurancecoverage under an assistance program, coverage of the employee or dependentunder the assistance program is terminated as a result of loss of eligibilityfor such coverage, and the employee requests coverage under the group policy,contract or plan not later than 60 days after the date of termination ofcoverage under the assistance program; or
2. The employee or dependent becomes eligible under anassistance program for premium assistance for the purchase of coverage underthe group policy, contract or plan, including contributions to the cost ofemployer-sponsored health insurance pursuant to subsection C of § 32.1-351.1,and the employee requests coverage under the group policy, contract or plan notlater than 60 days after the date the employee or dependent is determined to beeligible for such premium assistance.
C. Any employer providing health insurance coverage for hisemployees under a group accident and sickness insurance policy, or subscriptioncontract, or other evidence of coverage within the Commonwealth, shall provideto each employee a written notice informing the employee of premium assistanceopportunities currently available for the employee or the employee's dependentsthrough the Commonwealth's assistance programs. For purposes of compliance withthis subsection, for employees residing within the Commonwealth, the employermay use a Virginia-specific model notice developed in accordance with section701(f)(3)(B)(i)(II) of the Employee Retirement Income Security Act of 1974 (29U.S.C. § 1181(f)(3)(B)(i)(II)). An employer may provide the Virginia-specificmodel notice concurrent with (i) the furnishing of materials notifying theemployee of health plan eligibility; (ii) materials provided to the employee inconnection with an open season or election process conducted under the plan; or(iii) the furnishing of the summary plan description as provided in section104(b) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. §1024).
D. If an employee or the employee's dependents are coveredunder an assistance program and potentially eligible for premium assistance forthe purchase of coverage under the employer's group health plan, the planadministrator of the group health plan shall disclose to the Department ofMedical Assistance Services, upon request, information about the benefitsavailable under the group health plan in sufficient specificity, as determinedunder regulations of the Secretary of Health and Human Services in consultationwith the Secretary, that require use of the model coverage coordinationdisclosure form developed under § 311(b)(1)(C) of the Children's HealthInsurance Program Reauthorization Act of 2009, so as to permit the Departmentof Medical Assistance Services to make a determination concerning thecost-effectiveness of the provision by the Commonwealth of contributions to thecost of employer-sponsored health insurance, through premium assistance for thepurchase of coverage under such group health plan, and in order for theDepartment of Medical Assistance Services to provide any required supplementalbenefits under an assistance program.
(2010, c. 504.)